title: Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience.
abstract: After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80 mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5 g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48 h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P = 0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. Electronic address: christoph.luebbert@medizin.uni-leipzig.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lübbert
authors.forename: Sarah
authors.initials: S
authors.lastname: Faucheux
authors.forename: Diana
authors.initials: D
authors.lastname: Becker-Rux
authors.forename: Sven
authors.initials: S
authors.lastname: Laudi
authors.forename: Axel
authors.initials: A
authors.lastname: Dürrbeck
authors.forename: Thilo
authors.initials: T
authors.lastname: Busch
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.forename: Arne C
authors.initials: AC
authors.lastname: Rodloff
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003091:Colistin / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D005858:Germany; D006115:Greece; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; C491478:beta-lactamase KPC-2; D001618:beta-Lactamases; D003091:Colistin
keywords: Antimicrobial resistance; Colistin; Gentamicin; Klebsiella pneumoniae carbapenemase (KPC); Outbreak; Selective digestive decontamination (SDD)